The FDA is holding open meetings in October to obtain patient and doctor input on female sexual dysfunctions, specifically low desire. Now since it is the FDA, they are hoping to gain momentum on developing a medication that can treat lack of sexual desire. Which makes those of us who work with people struggling with sexual concerns sigh with frustration, “As though it is that simple.”

Sexual desire is complex. So much so that we can also say it is mysterious. Why we crave what we crave, why we crave it sometimes and not other times, why we are drawn to certain people, all questions without clear answers. And why we can’t just convince ourselves to want sex when it the person, place or time are convenient? That is a question that many people ask themselves. Low sexual desire is only a clinical issue when someone wants to want sex. But wanting to be sexual is not the same thing as desiring sex in that moment. And so many people are seeking their sexual desire spark to reignite.

There are physical issues that come into play with low desire, certainly. Hormones, brain chemistry, stress levels, exhaustion, side effects from drugs, general health and more should be considered. But so should emotional stressors, lifestyle, religious or spiritual conflicts, body awareness and acceptance, beliefs about sex and pleasure, traumas and fears, self image, lack of sex education, ability to enjoy sexual stimulation, and on and on. And I haven’t even started listing all the ways the relationship the person is in may affect their level of sexual desire. An issue that starts from one stimulus, say back pain, can lead to a pattern of saying no to sex, which leads to distance and resentment in a partner, which leads to less desire to be with them, which leads to less positive thoughts about sex…You can see how things interplay.

Even if the FDA can create a pill that motivates sexual desire would we want to take it? There is a creepy factor in feeling as though your sexual desire is manufactured. What invites us to ask ourselves, what is “real” desire. Desire is not just physical, nor just emotional, or relational. Our sexuality is interlaced with all aspects of our lives; that is one reason it is so potent. Sexual happiness can heal us on many levels and sexual unhappiness can trouble us on many levels. Desire draws on multiple aspects of Self, and my sense is that many of us want it that way.

There is a group specifically challenging the medicalization of sex, called the New View Campaign. Let’s keep our approach to sexual health diverse and multi-dimensional.

Remember the hullabaloo about the supposed trend of teenagers throwing parties where the girls line up to give all the boys blow jobs while leaving their mark with their lipstick color? Remember all that? Oh boy, our teens were just out of control. Hopefully somewhere along the way you also heard that this was an overwrought exaggeration manufactured to create a stir. No rainbow parties didn’t happen.

Of course if we had taken a few minutes to really think about this, most semi-informed people would have seriously questioned the whole premise. I mean, even highly hormonal teenage boys are not going to be able to sustain for a series of blowjobs in a row, at least not to the hysterical degrees this was described –“I heard every girl on the cheerleading squad did this!”. And even if we are imagining brief oral encounters, the lipstick leaving a distinctive mark thing is highly suspect. But okay, we didn’t think that hard about it. So the interesting question becomes, why do we want to believe these tales when they come around?

Why is each generation so willing to be convinced that the younger generations are having more extreme sex than they did, that sexual morals have turned some terrible corner, that teens need to be protected from themselves? There is simmering moral panic about the new “hook up culture”. And yet, recent studies have found no significant difference in the amount of sex college students have been having for the past 2 ½ decades. That’s since 1984 for those of you feeling math challenged today. A recent look into college kids sex lives, found that of current students 59% reported having sex weekly or more in the past year, compared with 65% in the 1980s and '90s. The groups showed similar patterns in the number of sexual partners in the past year: about 32% reported having more than one partner. Sure there seem to be more liberal ideas and values about sex among younger adults now and less pressure to identify a sex partner as a potential life partner. But if we look all the way back at the Kinsey Studies we see that much of the true sexual revolution has been in choosing to no longer hide sexual behavior that has been common for quite some time. So if sexual behavior is really not all that different than it has been, does that disappoint you?

And maybe that is the crux of it, we want to believe that sexuality is undergoing incredible changes. Maybe the middle-aged among us want to confirm their feelings of alienation from youth culture by thinking that it is ALL different now. Maybe we like to blame any sexual boredom we have now on the belief that “my generation never really got to be sexually free”. Maybe we are all trying to get vicarious fantasy material and want to read about more extreme sexual environments, even if they are made up to outrage us. Certainly the youth don’t want to think about their parents having sex like they are having. And vice versa. But more concerning to me are the underlying fears about sex that I see represented in our ongoing sexual panics about the youth. The fear that sex is an out of control force that only harsh social morals will protect us from. The fear that sex outside the context of married monogamy will lead to chaos. The fear that the existence and availability of sex will victimize us all. The fear that we cannot trust ourselves. Those are the aspects of sex that I hope we are changing, generation by generation.

What would the media like us to believe about women’s sexual confidence? I see a lot of messaging out there designed to convince us that American women are getting more and more sexually bold, empowered, and creative. Call it the Sex & the City affect or the Miley Cyrus affect, if you like. What we see are stories about how we are increasingly more sexually liberated and daring. We see feminist empowerment portrayed as the right to be unabashedly sexy (you can twerk if you want to!).But, in reality, for many people these public displays of sex seem to be making them feel more inhibited rather than less.

Take for example a recent comparison of sex questionnaires, from 2 very mainstream media publications, Glamour and Mademoiselle, looking at people’s answers from 1993 and 2013. Sure, there was some great news about women receiving more oral sex than before and more women have used a sex toy. But it also showed that 48% of the women questioned felt that men enjoy sex more than women, a sharp rise from the 33% who said that in 1993. So, all the talk about women’s increasing sexual ownership and desire are not translating to people’s actual bedrooms. And here is one potential reason, the surveys also showed that 73% of women now said that they would enjoy sex more if they lost weight! This number is staggeringly sad on its own, but even more dismaying in relation to the survey results from 1993 in which only 39% of women said this. Suggesting, in relation to body image empowerment is declining.

It is a good thing to like the way you look and to feel comfortable in your own body. But let’s be clear, there is not a lot that 20 extra pounds of fat can do to decrease your sexual pleasure – except for what your mind does with it. Sure being obese may limit some positions. Being out of shape may limit your endurance. But sex can still be fun. Orgasms will still feel good. And, the part that is clearly the hardest for people to accept – your partner can still desire you, think you are hot, and enjoy the privilege of interacting with your body. The fact that so many women are linking weight loss to their ability to enjoy sex speaks to the cruelty and arbitrariness of our minds. You can decide that you only have the right to enjoy sultry, uninhibited sex if you look like an airbrushed advertisement. You can turn off desire by allowing critical voices free rein in your head. You can doubt your partner’s touch or belittle their passion while with you. You can hold out for impossible standards while your body does its natural thing and ages. But it is such a waste.

I share with the mass media a desire to tell a story of sexual liberation. I just acknowledge that there is still a battle people need to fight in their own minds to really liberate themselves, and so many of us are losing it. And the cost is denying something that is natural, that we don’t have to purchase or earn, that always belongs to us – the pleasure our body can take in sexual stimulation.

Research released this year has shown that instances of sexual coercion among teens are disturbingly high. What was ground-breaking about this study is that it focused on self reports of perpetration. It asked questions about sexual coercion- verbally intimidating, pressuring, using guilt, getting someone drunk, or harassing behaviors- as well as forced sexual contact. Teenagers were asked if they “had tried to make someone have sex with me when I knew they didn’t want to”, or “made someone have sex with me when I knew they didn’t want to”. And based on their own responses – nearly 10% of teens have been sexually coercive.Also disturbing are patterns around personal responsibility. Fully 50% of the perpetrators said that the victim was completely responsible for what happened. And by the way, by the age of 18 perpetrators were equally boys and girls.

A 2008 study by the National Campaign to Prevent Teen Pregnancy looked at teens’ behaviors around sharing sexual content online. They found that 25% of girl and 33% of boys reported that they had been shown naked pictures intended to have been sent privately to someone else.Add this to what we have seen in the news about patterns of sexual harassment and bullying among teens and children.

I have believed for a long time that we should to be providing better and more comprehensive sexual education. Now it is clear to me that not only do we need to talk about sexual health and safety, but we need to be talking about sexual respect. It is time to define polite sexual conduct. And to erase once and for all the insidious idea that if someone is behaving sexually, they no longer deserve respect.

If kids are learning just by observing what is going on around them, then I can understand how they would be confused about how to treat others respectfully. In this era of decreased privacy and people’s personal lives as public entertainment, it is critical to teach about personal privacy and choice. Maybe the ever- intensifying ramp up from afternoon talks shows featuring humiliations, have numbed us to other people’s shame and turned us into virtual perpetrators, invited to laugh at someone falling down drunk and flashing their underwear. Humiliation has become entertainment. In this environment, how do we talk to kids about vulnerability? How do we help them to separate how we relate to the “real lives” on TV from how we relate to real people in our lives? How, in a world of selfies and sex tapes, do we talk about the fact that many people want their sex life to be private and that beginning a sexual relationship with someone can be a tender, trusting act? We need to explain why it is ok to laugh at the sexual behavior of “Carlos Danger” but not at the girl in your class who sent a topless pic to the person she has a crush on. And while we are at it, we need to talk about handling frustration and that you will not get to satisfy every desire you have the moment you have it, regardless of what the constant availability of nearly everything else may imply.

Maybe we can tell ourselves that as adults we that we are clear on where to draw the line between harmless amusement at other’s expense and actual harm, or who has abdicated their right to sexual choice or privacy. But it is time to admit that kids aren’t clear about that.

There are two new products on the market to treat early ejaculation in men, and sadly, I think they reflect the limitations in the way we view sex. Both products are spray numbing agents designed to reduce sensitivity in the penis. In truth men have been trying numbing agents of various sorts in hopes of lasting longer for years, so the real invention now is that the spray apparently doesn’t transfer to the partner. I have no doubt that by reducing pleasure they allow a man to last longer, but I have to ask – is that an acceptable trade?

First as a sex therapist, I think it is sad to settle for a solution which requires one person to enjoy sex less so the other can enjoy sex more. And, in most cases, it is not necessary. Many times early ejaculation happens because the man is unaware of his level of arousal, so he is tipped over the edge into orgasm before he wanted to be. Often times he is distracted by thinking about his performance, worrying about when he will come, or wondering if his partner is close. Actually learning to become MORE aware of his sensation and messages from his body can help him to pace his arousal, change the level of intensity for himself, and possibly feel more in control as well. Becoming numb will not help to build a relationship to his arousal, it will just help him last longer, as long as he is numb.

The other sad aspect of this is how it encourages us to limit our sexual scripts. One approach to dealing with early ejaculation is to expand your sexual play to include a variety of things that feel good and give pleasure, using hands, mouths, skin, toys, etc, so that penetrative intercourse is only one possible aspect of a sexual experience. That way orgasm for either partner can happen at any time and both know that there are still many ways to be satisfied. Penetration may still be the preference, but we might question the impulse to numb someone’s genitals if we didn’t see intercourse as the only “right way” to have sex.

And speaking of numbing genitals – can we for a moment imagine the outrage if a company was marketing a product to numb women’s vaginas so they could have sex longer? Think that would be considered an acceptable solution? No, women would be angry about being treated like objects and insulted that their sexual pleasure was considered irrelevant to the sex act. Maybe we could give men the same respect and see their ability to have intense, fully sensate sexual pleasure as important. Let's shoot for the stars - everyone's pleasure is important!

I hope some of you took part in the happy celebrations this past week after the Supreme court ruled to nullify the federal law defining marriage as between a man and a woman and to validate the right of all of us to choose to marry the person we love. There are, last count I saw, 1138 Federal rights given to married couples in the US, so there is a lot at stake for many families, and a lot to celebrate.

It was a tight vote, 5-4, and the court chose to not make their own decision regarding California’s case challenging the state’s federal court decision that banning gay marriage is unconstitutional so they passed up this opportunity to protect the right to gay marriage throughout the country. Still, this is historic and has opened doors to gay and lesbian couples to now have their commitments, families, identities, and love honored in the ways straight people have been able to for hundreds of years.

Another story with less coverage also gave me hope this week and I want you to know about it. Alan Chambers, president of Exodus Christian Ministry group one of the most influential groups in the ex-gay movement, has announced that he has closed Exodus. Not only has he shut down this organization, he has openly spoken out, apologizing for the harm Exodus has done. For 37 years this group, and several others, have been selling people the idea that “reparative therapy”, usually a series of painful and/or shaming aversion techniques, and prayer will turn people straight. In 2009 the American Psychological Association made a clear statement that reparative therapy does not work, is in fact harmful and that being gay is a natural thing and not something that needs to be changed. Still groups like Exodus kept going. For Alan Chambers to come forward now and say he was wrong, that he has caused unnecessary trauma, is powerful. It will not change the horrible experiences that many people went through because of reparative therapy, but Chambers apology may change some minds in the Christian community that looked up to him, the people who Chambers now described as, “imprisoned in a worldview that’s neither honoring toward our fellow human beings, nor biblical”.

So it is a time for celebration. It is also a time to recognize that tides do turn and even our enemies can sometimes hear us if we keep talking to them. As we continue to fight for equality and compassion around the world, it is also perhaps important for us to ask ourselves if our own hatred or fear are getting in the way of us moving forward in the way we know is right. To ask, if we have stopped talking to certain people, if we have given up on people’s ability to change, if we are doing our own demonizing. Maybe Alan Chambers can inspire us to ask ourselves, are we willing to forgive – when appropriate - and start a new era? Are we willing to let our hate change, disappear, make space for something new?

March 14th has been declared Steak and Blowjob Day, according to a group of men who are obviously comfortable asking for what they want. This holiday is being presented as a counterbalance to Valentine's Day being traditionally more focused on women's ideas how someone should show their love. I personally find the idea of creating a holiday that really addresses your wishes charming and invite all of you to think more creatively about how the world, and your partners, could best show their love and appreciation for you.

So before any of you turn this in to a gender battle of what men want versus what women want or think "oh how dare they!", imagine this - what if it was totally okay to ask for elaborate celebrations of you? What if everyone got to design a day full of things that make them happy? What if there was enough affection to go around and so we could all say what we want without feeling guilty? What if we felt a sense of freedom and generosity about doing things for our partners and inviting them to do things for us? What if asking for sexual pleasure was embraced as part of building joy in our lives? And once you have pondered that ask yourself, why isn' t it like that?

So in honor of Steak and Blowjob Day (aside from the more obvious ways to celebrate, if those appeal) I suggest this - design a holiday for yourself. Be extravagant. What is it that would really make a day feel like it was all about you? If you have a partner or partners share it with them. Maybe you can pick a date for National ______________ day. If you feel at a loss or too shy to have a day all to yourself, may I suggest Ask For What You Want Day. That should get you started.

I am sure there is a lot unknown and unclear about the Manti Te’o virtual girlfriend situation. If you haven’t read about this already, a synopsis is; football player Manti Te’o was hoaxed by a friend, who had unrequited romantic feeling for Manti Te’o, into having an online and phone relationship with a fictional woman. This relationship apparently went on for 3 years. After this time, the friend had the fake girlfriend die of leukemia. Manti Te’o went public with his grief and the hoax was revealed.

Now I feel sad for the suffering of everyone in this story and am unwilling to speculate about how this all unfolded. As a couple’s therapist however, it does bring up some fascinating questions about our current cultural models of relationship and intimacy and how social media and technology are re-shaping what it means to be connected. I have seen priorities change and more of more of the meat of communication happening through text or online sites. And while I recognize the convenience of being virtually connected, I worry about some of the deeper impacts on our relationships. I think it is important to ask ourselves some questions as we navigate these cultural changes.

Do we now think it is reasonable to have a significant relationship with someone that we cannot make time to see in person in over 3 years? Have we developed a cultural model in which we are all so busy that actually being physically together is negotiable? A 3 year romantic relationship is an extreme example, no doubt, but I encourage you to think about your friendships and how often you now prioritize updating posts so that people are “caught up with your life” versus making plans to see someone live and in person. How much time do you spend with romantic partners that doesn’t involve looking into screens? How many relationships are you willing to spend energy on when the thought of actually doing something with that person is unappealing?

Do we believe that people’s words are the core of who they are and the primary way to get to know them? As a therapist, I see every day the difference between what people say and what they feel, in fact this is much of what couples therapy is meant to reveal – the truth functioning underneath all the words. Now that most everyone has an online profile (or two), are we relying on that manufactured information to get to know someone? I recently read that people no longer know what to talk about on first dates because they have already read a basic bio of the person, which leads me to wonder – have we forgotten how to talk about our lives, the things we like, the dreams we have? Are we losing the gift of reading subtle cues from people, body language, eye contact, even the way we respond to the world around us? I remember when I was dating we learned a lot from observing how a person treated the waitstaff. Is this kind of social interaction irrelevant now? Is how someone literally moves through the world - how they drive, how much patience they show in doing tasks, if they move out of the way for other people in a crowded space- no longer considered part of who they are? Do we know the difference between persona and personality? Do we care?

And, of course, I do not know what kind of sexuality was or was not being expressed in Manti Te’o’s virtual relationship, but I worry for us all about the beautiful, awkward, sweaty, intimate, vulnerable, bonding experience of human sexuality being squeezed out by a reliance on the ease of words and pictures, fictional stories and our own minds. Virtual sex can be a fun addition but I hope we never lose sight of our desire for the astounding, risky experience of being physical with another person, and what it asks of us.

I have my own “connections” to celebrities, writers, artists, even politicians, that I will never meet in person. And I will grieve for them when they are gone and no longer playing an active part in my world. I believe it is good for us to learn from strangers, to allow ourselves to feel love for people far apart from us, to even develop stories about what they are like in person. But I hope I never lose sight of the fact that I do not know these people – that, in fact, they are a mystery to me, no matter how much written material I read about them. I hope I never forget to value the subtlety and fragility in the ongoing process of really getting to know someone.

On December 6th, the Church of Jesus Christ of Latter Day Saints published new website opening up a new kinder conversation around homosexuality than they have been known for I the past. Their key statement reads,

“The experience of same-sex attraction is a complex reality for many people. The attraction itself is not a sin, but acting on it is. Even though individuals do not choose to have such attractions, they do choose how to respond to them. With love and understanding, the Church reaches out to all God’s children, including our gay and lesbian brothers and sisters.”

Even though this may not be all we could hope for in terms of acceptance of homosexuality as a natural and healthy part of human sexual expression and identity, it is a huge step. For the church to acknowledge that study after study, and story after story, have shown that sexual orientation is not a choice but rather an innate part of each of us, changes how society must respond. To honor that a person is born loving who they love and attracted to who they are attracted to, then to persecute them for the qualities they were born with (one could say qualities that are“god given”) is unfair and unkind. I have heard this from Catholic priests when I was in Uganda who told me directly, “if we come to believe that homosexuality is a part of the person when they are born, we will have to treat them differently. This would fundamentally change how we see this issue”.

Now the new statement by the Mormon church, will not affect Catholics in Uganda, nor is it necessarily going to stop the church from trying to limit homosexual freedoms or rights for gay and lesbian couples. But it will require a new approach, it will validate the experience of the many gay and lesbian people who know, for them, love and desire is not a lifestyle choice. And it does call for love and understanding; that is a big step.

Melissa Fritchle is the author of The Conscious Sexual Self Workbook and a Holistic Psychotherapist, licensed in California as a Marriage and Family Therapist (Lic#48627). She has a private practice specializing in Sex Therapy and Couples Therapy. She travels far and wide, internationally and on the internet, to spread compassionate, sex positive, diverse, realistic sex education.